Lawmaker sees pressure rising for action on SGR

What goes down, sometimes also comes back up.

And that worries Rep. Michael Burgess (R-Texas), a physician representing the northwest suburbs of Dallas who co-chairs the Congressional Health Caucus and is vice chairman of the House Energy and Commerce Committee's health subcommittee. In that role, he has been focusing on a replacement for the Medicare sustainable growth-rate physician payment formula.

On Feb. 5, the CBO reported that it would take $138 billion to replace the SGR, which was 40% lower than the $245 billion projection it released last August. (The figure is based on the cost of repealing the formula and freezing physician Medicare pay rates for 10 years.)

Burgess recently told Modern Healthcare, “The score given by the Congressional Budget Office did breathe a lot of life back into this. There's no question that that altered the discussion in a positive way.”

But Burgess is concerned that what went down may go back up, and there is a sense of urgency to draft and pass an SGR replacement before new recalculations produce a higher figure.

“That puts pressure on us,” he said. “By my own internal clock, I think it really needs to happen by early summer—like June.”

Burgess emphasized that, in terms of a timeline, he was speaking as an individual and not on behalf of the committee or the Republican Party.

“The wheels of the Congress move very slowly, so a more realistic goal would be by the August recess,” Burgess said, adding how—after that—the congressional calendar gets very crowded, and it may be more difficult to get an SGR measure passed.

Under the SGR, provider Medicare fees are scheduled to be cut 24.4% starting Jan. 1, 2014, unless Congress acts to replace the formula or temporarily suspend the decrease.